Study Links Patient Use of Clinical Services With Online Access to Medical Services, Clinicians

Patients with online access to medical records and clinicians tend to use clinical services more than patients who don't, according to a study published on Nov. 20 in The Journal of the American Medical Association.

The study, which assessed whether Kaiser Permanente Colorado's online access system, MyHealthManager, could substitute for traditional health care services, found significant increases in clinical services among MyHealthManager users vs. nonusers. Specifically, results showed increases in the per-member rates of office visits (0.7 per member per year; 95 percent CI, 0.6-0.7; P<.001) and telephone encounters (0.3 per member per year; 95 percent CI, 0.2-0.3; P<.001). There was also a significant increase in per-1000-member rates of after-hours clinic visits (18.7 per 1000 members per year; 95 percent CI, 12.8-24.3; P<.001), emergency department encounters (11.2 per 1000 members per year; 95 percent CI, 2.6-19.7; P=.01), and hospitalizations (19.9 per 1000 members per year; 95 percent CI, 14.6-25.3; P<.001) for online users vs. nonusers.

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According to the study authors, the overall findings suggest that the relationship between online access and utilization is more complex than the simple substitution of online for in-person care. They argue that further research is needed "to evaluate why patients seek and subsequently use online access and whether online access affects health outcomes beyond utilization." In addition, they note that comparisons of clinical outcomes between online users and nonusers may help physicians and health care systems better tailor their services to patient needs. They also urge a closer look at the costs and benefits of online access to health care services, virtual visits and clinical decision making. 

In a related editorial comment, David Bates, MD, MSc, and Susan Wells, MB, ChB, division of general internal medicine, Brigham and Women's Hospital, Boston, add, "the data on utilization are uncertain and personal health records (PHRs) may not decrease health care utilization. However, electronic access to PHRs represents an extremely powerful tool from a variety of perspectives and can help empower and engage patients." Moving forward, they note that more data on how to use them and what specific modules and applications will be beneficial are clearly needed.

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